S284: RISK FACTORS AND OUTCOMES OF PATIENTS WITH HAEMATOLOGICAL MALIGNANCY AND COVID-19: ONGOING REDUCTION IN MORTALITY DURING THE 3RD WAVE OF THE PANDEMIC
Authors: J. Maddox
Journal: HemaSphere (2022)

Background: It was established early in the COVID-19 pandemic that patients with cancer, in particular haematological malignancy, had worse outcomes than non-cancer patients. There is a lack of recent data to describe how mortality in patients with haematology malignancy has changed with widespread vaccination and several effective treatments now being available. Aims: Based in a large NHS Trust in the North-East of England, our aim was to identify all local patients with haematological malignancy who had contracted COVID-19 since the start of the pandemic. We then examined these patients in more detail to ascertain risk factors for mortality, and how this has changed over the course of the pandemic. Methods: We included patients with an active diagnosis of haematological malignancy, or those who had received potentially curative treatment within the past 3 years. We excluded patients with pre-malignant conditions. Data up to the end of November 2021 found 213 eligible patients. Nearly all patients identified in the 1st wave of the pandemic were identified from hospital testing, reflecting the lack of availability of widespread testing in the community. More recently, patients identified in the community have predominated. Results: Overall mortality following COVID-19 infection was 21.6% at 4 weeks and 27.7% at 8 weeks after COVID-19 diagnosis. Mortality was highest in wave 1 (March – June 2020), decreasing in wave 2 (Sept 20 – March 2021) and again in wave 3 (May 2021 – current), with 4-week mortality figures of 44%, 26% and 8% respectively. It should be noted that widespread community testing was not available early in the pandemic so the recorded cases in wave 1 were sicker patients needing hospital care. Removing pillar 2 data still shows a reduction in 4-week mortality over the course of the pandemic, from 46% (wave 1) to 39% (wave 2) and 8% (wave 3). Although official COVID-19 mortality figures only include deaths within 4 weeks of a confirmed infection, we note that the Kaplan-Myer mortality curve did not level out until 6-8 weeks after initial infection (figure 1). Overall mortality at 8 weeks was therefore higher at 61% (wave 1), 31% (wave 2) and 11% (wave 3). The main risk factor for mortality was patient age, with 8-week mortality in age groups <60yr, 60-69yr, 70-79yr, 80-89yr and 90+yr being 2%, 26%, 30%, 51% and 86% respectively. Although men comprised the majority of detected cases (62%), mortality at four and eight weeks was near identical between sexes. Although disease subgroups were relatively small, we found the highest COVID-related mortality in patients with CLL (43%) and MDS (42%). It is perhaps not surprising as these two disease groups also had the highest mean patient ages. Patients receiving chemotherapy had no significant increase in 8-week mortality compared to those not receiving chemotherapy, 30% vs. 27% (p=ns). The presence of neutropenia was however a risk factor for mortality. Patients who were neutropenic at the time of infection had an 8-week mortality of 43%, compared to 25% in those who were not neutropenic (P=0.04). Image:Summary/Conclusion: Overall, COVID-19 related mortality in patients with haematological malignancy has significantly declined over the course of the pandemic. The main risk factor for death is increased patient age, with neutropenia also being a risk factor.